Diabetes Is Seen As a Rising Risk In Mothers-to-Be

By N. R. KLEINFIELD

Published: February 18, 2006

It has long been something of a quirk in the grim universe of diabetes: a small number of pregnant women would become temporarily diabetic. With proper care, the consequences were often thought to be mild. The babies were usually healthy. And the condition would vanish after the delivery, like a cough or a headache.

But, not unlike the wider expansion of diabetes, this disorder is now growing, and indications are that it is growing fast. In New York, so-called gestational diabetes has risen by nearly 50 percent in about 10 years.

There is also broader recognition that in the lives of many pregnant women, the arrival of the condition is significant and its impact can be grave: not only does it identify those women at particularly high risk to develop permanent diabetes, but it may contribute to their babies' eventually getting diabetes as well.

Health care officials worry that insufficient attention is being paid to the rising number of cases, apparently being propelled by genetically susceptible women entering pregnancy too fat. The inattention, the officials say, is allowing young mothers to be saddled with a harrowing lifelong disease and increasing the risk to their children of ultimately sharing that troubling destiny. It is hard to say just how alarming this will become. But those who study the diabetes epidemic are concerned that it's one more time bomb.

''It's really disturbing to us that women come into their pregnancies obese and then leave them even more obese,'' said Barbara Hackley, a certified nurse-midwife at the health center of the Children's Health Fund and Montefiore Medical Center in the South Bronx. ''I've seen weight gains during pregnancies of 50 to 60 pounds. We've had 11- and 12-pound babies that are very dangerous to deliver.''

Gestational diabetes, like other forms of diabetes, is characterized by dangerously high levels of sugar in the blood. Many women who develop it have never even heard of the disorder. Afterward, they never think much about it, unless visited by its potential legacy, Type 2 diabetes, a progressive, potentially fatal illness that can produce a barrage of complications, from strokes to decaying limbs.

In 2001, the latest year researchers have studied, there were 4,200 cases of gestational diabetes in New York among women who gave birth to a single baby. Experts believe wider education about the condition might allow some heavy women, through better diet and exercise, to avert it before they become pregnant.

Furthermore, experts say, many mothers are inadequately counseled after delivery by busy clinicians -- or are unable to absorb the message -- about the need to monitor their weight and blood sugar, as well as their child's, because of the danger of chronic diabetes. A surprising number, doctors say, never even bother to confirm that the gestational diabetes went away.

Take the weight narrative of Andrea Reyes. At 21, pregnant with her first child, she weighed 153 pounds. She tacked on just seven pounds during the pregnancy, because the baby came early. But instead of shedding her baby fat, she said, ''I ate the same food; but I ate more.''

Four years later, pregnant with her second child, she weighed 190. During her pregnancy, doctors found that she had gestational diabetes, which usually shows up 24 to 28 weeks into pregnancy. She had no idea what it was. The baby was fine, and the diabetes disappeared, but it was resurrected during her third pregnancy, in 2001. She weighed 193. Her son was large -- 9 pounds, 9 ounces -- and had low blood sugar, complications of the condition.

Again, the diabetes subsided. But her doctor cautioned her that if she did not diet and exercise, she might acquire permanent Type 2 diabetes. In May 2004, after fitful progress, that's what happened.

She is now 32, a sprightly woman with dark hair knotted in a ponytail who lives in the South Bronx and peddles fruit salads in the summers. She takes pills and insulin, and sometimes finds herself dizzy.

Though she winnowed her weight down to 180, she has put on five pounds in the past month.

''I know,'' Ms. Reyes said sheepishly, ''too much.''

Her doctors have advised her that she needs to keep an eye on her son, whose weight is now normal. ''I know,'' she said. ''I worry.''

The dimensions of gestational diabetes are imprecise, and there is considerable disagreement about how vigorously to treat it, especially milder cases, and how much difference treatment makes.

The disorder is not tracked regularly in the city or nation. Estimates are rooted in scattered studies. In its first attempt to measure the problem, the New York City Department of Health and Mental Hygiene, in a paper last September in the American Journal of Public Health, said that a review of births between 1990 and 2001 found that the prevalence had leapt to 3.8 percent, or about 4,200 pregnant women in 2001, from 2.6 percent.

There was a pronounced increase among younger women and Asians, who tend to get diabetes at lower weights. With South and Central Asian mothers, prevalence hit 11.1 percent, one of the highest documented levels in the country. An increase of more than 75 percent occurred among women delivering before age 35. Although the study did not track the weights of mothers, it concluded that obesity was probably the principal force because it has been driving increases in Type 2 diabetes.